Fallen Angel

Kandahar, Afghanistan

I got the cryptic text message on my pager at about 4:20 this morning: Fallen angel, ETA 20 min.  I was dead to the world at 4:20, but I was pretty sure what fallen angel meant - a KIA was inbound.  Why were they texting me about this?  I rolled over, feeling pretty confident that I didn't need to go in for that:  I get all the pages that the folks on call get, so I know that if there are too many Alphas coming in for one ICU doc to handle, I can go in to lend a hand.  One person could handle a fallen angel, although I still found it curious that the Tactical Operations Center felt compelled to page about this.

I never got back to sleep.  At about 4:30 I got another text about the fallen angel, and that 13 were inbound.  I apparently did not know what fallen angel meant and if we had 13 inbound, that was a mass casualty.  I got up quickly this time and threw my uniform on.  This was going to be a long day, I knew it.  I had to at least find a clean pair of socks.

I ran into my colleague Corey and his roommate Joe.  None of us knew what was going on but we knew we needed to go in.  Maybe fallen angel was the name of a plane or helo squadron I thought to myself.  Maybe a small plane was shot down.

It is still murky to me what exactly fell out of the sky - I know now that it was a helo, but what kind?  We got to the trauma bay in minutes, thanks to the duty driver who picked us up.  The bay was packed.  I could here moaning and some patients yelling out.  I quickly surveyed the bays.  All of them were full - we have at least 13 bays, perhaps 14.  Generally traumas come in in 2's and 3's at most.  X-ray techs were wheeling their machines methodically into bays.  I snaked past the radiologist who was holding a probe covered in goo, heading for the next patient's abdomen, to see if it contained blood.  Breathing tubes were being placed into the trachea's of our crash victims, one, then two, perhaps five total.  I assessed a few patients and helped out where I could.  In no time one was rolled into the OR for surgery, then two more followed him.  A curtain to one trauma bay was closed and there was no noise coming out of that bay, no X-ray tech going in.

Full ICU Status Board

I and my ICU colleagues made it back to the ICU to help flush out whatever patients could go to the wards.  The new patients were already being filed in, one by one on their rickshaw gurneys.  Many would go to the OR later as they were presently mostly stable.  We were getting more news about what happened: a helicopter carrying at least 13 fell from about 200 feet.  No word about a rocket or gun shots - mechanical failure seemed to be the reason for this tragedy.



My prediction that it would be a long day - not a huge stretch of the imagination - was correct.  The fact that I was unshaven, hadn't brushed my teeth, and essentially was wearing the same thing I had started wearing on my call day 48 hours prior didn't help.  

The surgeons at the end of the day

By 4:30 that afternoon it was quiet enough for Jon and I to leave the mostly cleaned up mess for the on-call guy, Corey.  Poor Jon was worse off than myself - he had started his day at 3:30 am the previous day when a young child was medevac'd in - and really hadn't slept during that whole time.   We passed a handful of surgeons who were sticking around and nearly giddy that they had at least two more surgeries to go -- two more traumas had arrived, amputations, about 15 minutes before.  Welcome to the trauma bay that never sleeps.